Myxomatous mitral valve disease (MMVD), the most common heart disease in small-breed dogs, is characterized by mitral regurgitation (MR) resulting from valvular degeneration, which may progress to left-sided heart failure. This report describes the cases of three dogs with severe MMVD (American College of Veterinary Internal Medicine Stages C or D) who exhibited an unexpected spontaneous reduction in MR despite continued valve degeneration.

Three dogs initially presented with symptoms of heart failure and left atrial and ventricular enlargement. Standard treatment, including diuretics, improved their conditions; however, further monitoring revealed that the coaptation gap decreased due to mitral valve thickening, leading to a reduction in MR. This was accompanied by a significant decrease in heart size. As a result, diuretics were discontinued, and all dogs were successfully managed with pimobendan alone.

To our knowledge, this is the first report of spontaneous MR reduction in MMVD, where coaptation gap narrowing played a role in clinical improvement. These cases may broaden the current understanding of MMVD progression, suggesting that, in rare instances, changes in cardiac remodelling and clinical status can occur. Further research is warranted to better understand the underlying mechanisms.

This study was an exploratory secondary analysis of data from a previously conducted randomized controlled trial (RCT) involving older adults receiving long-term care (LTC). The present secondary analysis explored the effects of an accelerometer-guided self-monitoring intervention on prolonged sedentary behavior (≥ 30 min) and physical activity in older adults with cardiovascular conditions.

This exploratory secondary analysis used data from an RCT conducted at a Japanese daycare center (October 2022-January 2023). The parent RCT included 52 participants (26 in the intervention group and 26 in the control group). Of these, 36 participants with cardiovascular conditions were eligible for the present exploratory secondary analysis (intervention, n = 21; control, n = 15). The main outcome was prolonged sedentary behavior accumulated in bouts of ≥ 30 min. Other outcomes included daily step count, sedentary behavior in bouts of ≥ 1 and ≥ 60 min, sedentary bout counts and break counts, physical activity intensity, and EQ-5D-5L utility scores. Outcomes were analyzed using linear mixed-effects models.

Thirty-three participants with available baseline outcome data were included in the analyses (intervention, n = 19; control, n = 14). Significant group × time interactions were observed for step count, sedentary behavior in bouts of ≥ 1 min and ≥ 30 min, sedentary bout counts, and light physical activity (p < 0.05). Moderate-to-vigorous physical activity and EQ-5D-5L utility scores did not change significantly.

Accelerometer-guided self-monitoring may influence prolonged sedentary behavior and physical activity in older adults with cardiovascular conditions receiving LTC. These findings provide preliminary, hypothesis-generating evidence that self-monitoring may represent a promising approach to reducing prolonged sedentary behavior in older adults receiving LTC. Confirmation in adequately powered RCTs is warranted.

Foot drop is a common post-stroke gait impairment that reduces toe clearance and compromises walking safety. Existing assistive interventions are often limited by passive compensation, external power requirements, and manual tuning. Here, we introduce a wearable, gait-timing-adaptive, self‑powered neuroprosthesis (SPN) that augments ankle dorsiflexion and corrects gait patterns, avoiding labor-intensive parameter tuning and eliminating the charging and reliability burdens of external batteries. The SPN leverages gait's out‑of‑phase mechanics: it harvests mechanical energy during stance on the non‑paretic limb and immediately converts it into electrical stimulation of the tibialis anterior on the paretic limb during swing, increasing dorsiflexion when foot clearance is required. In ambulatory stroke survivors with preserved walking capacity, foot drop, and lower-limb impairment (Fugl-Meyer LE Score: 13-27/34, Modified Ashworth Scale-Ankle Plantarflexors: 0-2), the SPN assistance produced immediate, clinically meaningful gains during outdoor walking: dorsiflexion angle improved from -1.1° to 6.8°, walking distance increased by 67.3%, speed by 43.5%, and gait variability decreased by 71.9%. These findings demonstrate the SPN's potential to restore dorsiflexion, enhance mobility, and improve overall quality of life for individuals recovering from stroke, particularly those at later stages of life.

Palestinian refugee camps in the occupied West Bank share the same geographic space as adjacent urban neighbourhoods but remain socially, politically and institutionally distinct. This study examined whether refugee camp residence is associated with greater exposure to human rights violations, political violence, deprivation and poorer mental health. A cross-sectional survey of 3000 Palestinian adults was conducted in 2025 across three refugee camps and neighbouring urban areas. Multivariable logistic regression was conducted. Overall, 77.1% reported at least one human rights violation, 91.7% deprivation, 77.1% personal exposure to political violence, 81.1% witnessed political violence and 30.0% dissatisfaction with mental health. Compared with urban residents, refugee camp residents had higher odds of reporting any human rights violation (aOR 1.52, 95% CI 1.28-1.81), personal (aOR 3.48, 95% CI 2.54-4.78), household (aOR 4.24, 95% CI 3.62-4.98) and witnessing political violence (aOR 4.48, 95% CI 3.52-5.69), deprivation (aOR 1.60, 95% CI 1.34-1.91) and dissatisfaction with mental health (aOR 2.51, 95% CI 1.97-3.19). The results suggest that health inequities experienced by Palestinian refugee camp residents are produced through the cumulative effects of structural violence, deprivation and systematic human rights violations rather than by spatial location alone.

Aphasia affects both the individuals and their families, impacting communication, social connectedness, roles and mental health. The focus in neurorehabilitation often remains on the individual, yet research suggests that addressing the family as a system would be beneficial. It remains unknown to what extent this is translated into clinical practice.

To explore professionals' perspectives on communication support and training addressing the needs of families living with aphasia across disciplines, positions and stages of neurorehabilitation in Denmark.

An online survey with 21 items was developed and distributed via clinical networks and social media. The survey focused on characteristics of current services, perceived needs, barriers and facilitators related to communication support and training. Descriptive statistics and qualitative content analysis were applied.

A total of 285 professionals from different professions and positions completed the survey. The majority of respondents reported that their institution provided communication support and training for individuals living with aphasia and/or their relatives, but often inadequately and several unmet needs were highlighted. The need for a more systematic, flexible, tailored and outreached approach to communication training to address the multi-faceted and evolving needs of families living with aphasia was highlighted.

The results highlight the importance of supporting and training professionals in addressing the needs of families living with aphasia throughout the course of rehabilitation and life with aphasia. This highlights the necessity of developing and providing more flexible and tailored interventions directed at these families in order to achieve genuine and sustainable changes.

What is already known on the subject Aphasia impacts both the individual and their families, whose rehabilitation needs are complex and evolving over time. Family-focused interventions such as communication partner training (CPT) are recognised as beneficial yet remain inconsistently implemented and rarely embedded in routine clinical services. What this paper adds to existing knowledge This study provides insight into professionals' experiences with CPT and informational support. It reveals that while such services are often offered, they are rarely sufficient in term of timing, content and consistency. It identifies barriers to implementation, including organisational fragmentation, lack of structured training and limited interdisciplinary coordination. What are the potential or actual clinical implications of this work? The findings emphasise the importance of recognising the family as a unit of care in aphasia rehabilitation. To meet complex and evolving needs, rehabilitation should be tailored, repeated, outreached and flexible. Sustainable implementation of CPT requires organisational commitment and interdisciplinary collaboration, ensuring that support is both accessible and responsive.

Co-production is becoming an established methodology in mental health research, yet there remains a lack of condition-specific frameworks to guide its design and implementation. For bipolar disorder in particular, there is limited evidence on how to meaningfully engage lived experience experts in the context of possible mood instability and other impairments. This paper presents insights from a consultation with people with lived experience of bipolar disorder, aimed at developing recommendations for conducting co-production with people with bipolar.

A one-off, 1-h online consultation was conducted with four members of the AMBIENT-BD Lived Experience Advisory Panel (LEAP). The consultation used a semi-structured focus group format, guided by a topic guide, to explore strategies for recruiting and engaging co-producers in bipolar disorder research. Data were analysed using reflexive thematic analysis.

Four overarching themes were developed: (i) Communicating with co-producers- capturing how trusted channels and regular contact support recruitment and sustained engagement; (ii) Providing accessible information- addressing the need to balance sufficient detail with readable, low-burden formats during periods of instability; (iii) Building and sustaining trust- highlighting trust in the research process and partnerships with third-sector organisations as preconditions for meaningful involvement; and (iv) Perceived impact as a motivator- reflecting how community belonging and tangible incentives shape willingness to participate. A provisional set of practical recommendations was derived from these themes, including recruiting through trusted organisations, using non-technical language and multiple formats, offering meaningful incentives, and using low-burden communication methods during periods of unwellness.

Grounded in lived experience perspectives, this paper conceptualises co-production as a relational process in which trust, accessible communication and visible impact form the foundation for meaningful engagement with people with bipolar disorder. Positioned as a consultative contribution on the IAP2 Spectrum of Public Participation, the paper offers practical, mental health-specific guidance for researchers seeking to develop advisory groups and other participatory approaches with the bipolar population.

This study has been conducted in partnership with people with lived experience of bipolar disorder. They were involved in the conceptualisation, design and data collection of the study. They helped to inform the process of conducting a co-production with people with bipolar disorder. Findings from the consultation were shared with them in a separate feedback session.

Compassion-based interventions (CBIs) are effective transdiagnostic treatments for a wide range of psychopathological symptoms. While their efficacy is well established, their mechanisms remain insufficiently understood. Self-criticism (SC) has been proposed as a promising mechanism of change (MoC), given its central role in psychopathology and its theoretical link with CBIs. This study synthesises evidence from randomised controlled trials to examine whether reductions in SC mediate the effects of CBIs on psychopathological symptoms. Systematic searches in PubMed, Web of Science, Scopus and ProQuest identified 57 randomised controlled trials (n = 4877) of CBIs in adults reporting SC and psychopathological symptom outcomes, analysed using One-Stage Meta-Analytic Structural Equation Modelling (OMASEM). SC partially mediated the effects of CBIs on symptom reduction (e.g., depression, anxiety, eating disorders; indirect effect = -0.054, 95% CI [-0.085, -0.030]). Stronger mediation effects were observed in studies prescribing more daily home-practice minutes and shorter intervention duration. At posttreatment, CBIs achieved moderate reductions in SC (r = -0.20, 95% CI [-0.27, -0.13]) and psychopathological symptoms (r = -0.21, 95% CI [-0.27, -0.15]). Moreover, SC was positively correlated with psychopathological symptoms (r = 0.48, 95% CI [0.42, 0.54]), supporting partial mediation by SC. Considerable heterogeneity was observed across interventions and designs; 76.4% showed high risk of bias. These findings support SC as a potential MoC in CBIs and provide quantitative evidence for process-based formulations of CBIs. The results also highlight the clinical relevance of directly targeting SC in therapeutic practice and contribute to understanding the psychological processes underlying CBIs.

The Systematic Self-Reflection Model of Resilience Strengthening (Crane, Searle, et al., 2019) proposes that coping self-reflection on everyday stressors can generate coping-related insights that refine modifiable capacities for resilience (e.g., coping beliefs, coping adjustment, and coping-enabling resources), thereby increasing the likelihood of resilience. However, reflective engagement and insight generation may be constrained by individual and contextual factors, raising the possibility that externally modeled coping insights could scaffold subsequent self-reflection and strengthen downstream adaptation. This preregistered study tests whether narrative exposure that explicitly models coping-related insights enhances the effects of structured self-reflection among emerging adults (18-25 years). Participants (target final N = 400; recruited from Australia and the United Kingdom) will be randomly assigned to one of three conditions: (1) high-insight priming story + reflection, in which short video stories explicitly convey a coping-related insight; (2) low-insight priming story + reflection, in which the same stories omit explicit meaning-making; or (3) reflection-only. Participants complete five weekly tasks, with assessments at baseline (T1), post-intervention (T2), and 3-month follow-up (T3). Primary outcomes include coping-related insight (self-report and blind-coded written insights), resilient capacities (coping self-efficacy, coping adjustment, support-seeking intentions, perceived social support), and mental ill-health symptoms (depression and anxiety). Resilience is operationalized as stressor reactivity, symptom levels relative to stressor exposure, calculated as residualised symptoms after accounting for adversity and daily hassles, at each time point. We hypothesize that high-insight priming narratives will increase insight and resilient capacities and reduce stressor reactivity over time. Mediation analyses will test underlying mechanisms.

Rates of suicide deaths involving firearms have been increasing among Hispanic/Latino adults in the U.S. The high lethality of firearm suicide attempts and critical gaps in characterizing firearm suicide deaths among Hispanic/Latino adults may pose challenges to suicide prevention. However, there is little systematic knowledge about the circumstances that manifest among Hispanic/Latino suicide decedents who die by firearms or about how those circumstances may differ between female and male Hispanic/Latino firearm suicide decedents. This study aimed to descriptively characterize recurring circumstances preceding firearm suicide deaths among a large sample of Hispanic/Latino adults in the U.S. and to examine sex differences in the occurrence of these circumstances.

This study analyzed deidentified data from the National Violent Death Reporting System. The analysis included a large sample of 1,170 Hispanic/Latino adult firearm suicide decedents who died from 2013 to 2021 in the U.S. Given the limited etiologic characterization of firearm suicide among Hispanic/Latino adults, a qualitative content analysis with quantification was conducted to systematically review and code recurring circumstances experienced prior to death using free-text coroner/medical examiner and law enforcement narratives abstracted by the National Violent Death Reporting System. This study grounded circumstance definitions inductively, directly in the language and contextual descriptions present in the narrative data.

Six major categories emerged to organize the recurring circumstances preceding firearm suicide deaths among the individuals included in the study sample: behavioral health, physical health, relationship dynamics, socioeconomic instability, scene of death, and firearm access and storage. Behavioral health circumstances were commonly noted among the decedents in the sample, including known mental health conditions and depressed or melancholy mood. Relationship and socioeconomic stressors were noted for a meaningful portion of the decedents in the sample, including romantic relationship challenges, interpersonal arguments, and legal issues. Notable sex differences were observed; female decedents in the sample were more frequently documented as having prior suicide attempts and accessing another person's firearm.

Although descriptive, these findings provide population-specific context on the circumstances preceding firearm suicide among Hispanic/Latino adults, a group historically underrepresented in the firearm suicide literature. Several findings extend existing knowledge to a population for whom such evidence remains limited. Many identified circumstances are consistent with prior research on suicide broadly, underscoring their relevance within this population. In addition, this study's findings align with existing National Violent Death Reporting System variables, offering insight into the quality and utility of National Violent Death Reporting System data. This study provides a foundation for subsequent hypothesis-driven research on circumstances and risk factors preceding firearm suicide among Hispanic/Latino adults.

To examine the trend of locational equity in utilising Medicare-reimbursed psychiatric consultations (face-to-face and telepsychiatry) across states/territories.

Time series analysis of administrative data.

Medicare-reimbursed private psychiatric consultations.

Greater coefficients of variation (CVs) represented higher state/territory variations in per capita consultations (2005 Q3-2023 Q4). We ran an autoregressive integrated moving average model for telepsychiatry-related CV change, with restricted rural-remote telepsychiatry items (2005-2022) and unrestricted telepsychiatry items (2020 Q1-2023 Q4) as the predictors. We examined the association between distance from mean per capita consultations and the fraction of per capita telepsychiatry consultations using state/territory-level data in another regression analysis, with telehealth legislative policy changes as another independent variable.

Including telepsychiatry items since their introduction resulted in lower all-item CVs (i.e., reduced state/territory variation) than the corresponding CVs for face-to-face items only. The rural-remote-restricted telepsychiatry items had a larger effect than the unrestricted ones. Every 1000 restricted consultations were associated with 0.287 units of CV improvement (i.e., reduction in regional variation), in contrast to 0.007 units per 1000 consultations for unrestricted items. Telehealth-enabling policy changes significantly modified the association between distance from mean per capita face-to-face consultations and the fraction of telepsychiatry consultations. Lower per capita face-to-face consultations were associated with higher telepsychiatry fractions.

Telepsychiatry may help improve mental health equity. Bulk-billed, incentivised telepsychiatry for rural and remote areas may enhance regional health access.